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Refractory heart failure (RHF), or end-stage heart failure, has a poor prognosis and high case fatality rate, making it one of the therapeutic difficulties in the cardiovascular field. Despite the continuous abundance of methods and means for treating RHF in modern medicine, it still cannot meet the clinical needs of patients with RHF. How to further reduce the mortality rate and readmission rate of patients with RHF and improve their quality of life is still a difficult point in current research. In China, traditional Chinese medicine (TCM) has been widely used and has accumulated rich experience in the treatment of RHF due to its unique efficacy and safety advantages. Based on this, we comprehensively summarized and analyzed the clinical evidence and mechanism of action of TCM in the treatment of RHF and proposed urgent scientific issues and future research strategies for the treatment of RHF with TCM, to provide reference for the treatment of RHF.

Pediatric heart transplantation is the standard treatment for children complicated with refractory heart failure which is difficult to be treated by conventional surgery or drugs. At present, an increasing quantity of pediatric heart transplantation is being performed worldwide, whereas relevant experience is still lacking in China. In recent 10 years, significant progress has been achieved in pediatric heart transplantation. On one hand, the number of pediatric heart transplantation has been increased year by year. On the other hand, ABO-incompatible heart transplantation, application of ventricular assist device in children, and recipient-donor weight mismatch transplantation have been widely employed to resolve the shortage of donor heart in pediatric heart transplantation. However, relevant experience of pediatric heart transplantation is lacking in China, especially in understanding the indications of pediatric heart transplantation and the application of specific strategies for pediatric heart transplantation, etc. In this article, the development history, advances in therapeutic strategy and clinical prognosis of pediatric heart transplantation were reviewed. [ABSTRACT FROM AUTHOR]

Abstract As an emerging pacing technique, left bundle branch area pacing (LBBAP) has served as a physiological pacing modality that overcomes the limitations of His bundle pacing (HBP) or right ventricular pacing. Three patients with terminal heart failure who were waiting for heart transplantation and met the indications of pacemaker implantations received LBBAP. Symptoms were relieved and stabilized and eventually received heart transplantation. Diseased hearts from the recipients were dissected post‐transplantation, and the direct visual of pacing lead locations in the interventricular septum were evaluated, and the histopathological examination around the lead was conducted for the first time in human. As a result, we found that the locations of LBBAP leads were matched with fluoroscopic views during the procedure and Masson's staining showed extensive fibrosis occur around the lead but did not result in high thresholds.

Introduction: Investigation of the prognostic factors in patients with refractory heart failure (HF) undergoing continuous veno‐venous hemofiltration (CVVH). Methods: Clinical data of 146 patients with refractory HF between May 2018 and December 2020 were retrospectively analyzed and divided into survival and death groups according to the prognosis. Vital signs, inflammatory markers, and renal function parameters were compared before and after treatment. Results: Central venous pressure levels were lower, whereas serum levels of brain natriuretic peptide, oxygen saturation, and cardiac output were higher after treatment (p < 0.05). Heart rate, systolic and diastolic blood pressures, serum levels of C‐reactive protein, interleukin‐6, tumor necrosis factor‐α, interleukin‐8, blood urea nitrogen, creatinine, and 24‐h urinary protein were lower after treatment (p < 0.05). Conclusion: CVVH improved renal function and regulated blood pressure and vital signs in patients with refractory HF. Age, APACHE II score, disease duration, and hypotension were risk factors affecting the prognosis. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the efficacy and safety of dapagliflozin, a SGLT2i along with ARNI in refractory HFrEF irrespective of their diabetic status. Methods: We performed a retrospective analysis of 104 symptomatic patients of HFrEF despite of optimal medical management with ARNI between January–June 2020. Despite the optimal GDMT, dapagliflozin, SGLT2i was added inpatients withrefractory heart failure. At 6-months follow-up, the primary outcome was change in left ventricular ejection fraction, and secondary outcomes included changes in NYHA functional class, vital parameters, renal function, potassium levels, and NT-pro BNP levels. Results: The primary outcomeat 6-months follow-up was a mean change in left ventricular ejection fraction (LVEF) +9.00 ± 0.62 (p

Background: Advanced heart failure (AHF) secondary to myxomatous mitral valve disease (MMVD) in dogs has unclear predictive variables and survival time. Methods: This retrospective study included 38 dogs with AHF and 38 with stable congestive heart failure (CHF), both due to MMVD. Predictive variables for AHF were analysed, and survival times were calculated using logistic regression and the Kaplan–Meier method. Results: Left atrium to aortic root ratio, normalised left ventricular dimension at the end‐diastole and end‐systole, isovolumic relaxation time (IVRT) and early transmitral inflow velocity to IVRT ratio were associated with AHF progression. The median survival times were significantly longer in the stable group than in the AHF group. After AHF diagnosis, the median survival times for all‐cause and cardiogenic mortality were 194 and 354 days, respectively. Limitations: This was a single‐centre retrospective observational study. The study population was small, with breed bias (overrepresentation of Maltese dogs). Additionally, the treatment plans depended on clinical experience. Conclusions: AHF in dogs with CHF secondary to MMVD is linked to left heart chamber enlargement and increased left ventricular dimensions, significantly reducing survival time to around six months post‐diagnosis. Early recognition and appropriate management may improve outcomes, highlighting the importance of advanced treatment strategies. [ABSTRACT FROM AUTHOR]

As an emerging pacing technique, left bundle branch area pacing (LBBAP) has served as a physiological pacing modality that overcomes the limitations of His bundle pacing (HBP) or right ventricular pacing. Three patients with terminal heart failure who were waiting for heart transplantation and met the indications of pacemaker implantations received LBBAP. Symptoms were relieved and stabilized and eventually received heart transplantation. Diseased hearts from the recipients were dissected post‐transplantation, and the direct visual of pacing lead locations in the interventricular septum were evaluated, and the histopathological examination around the lead was conducted for the first time in human. As a result, we found that the locations of LBBAP leads were matched with fluoroscopic views during the procedure and Masson's staining showed extensive fibrosis occur around the lead but did not result in high thresholds. [ABSTRACT FROM AUTHOR]

Refractory heart failure (RHF), or end-stage heart failure, has a poor prognosis and high case fatality rate, making it one of the therapeutic difficulties in the cardiovascular field. Despite the continuous abundance of methods and means for treating RHF in modern medicine, it still cannot meet the clinical needs of patients with RHF. How to further reduce the mortality rate and readmission rate of patients with RHF and improve their quality of life is still a difficult point in current research. In China, traditional Chinese medicine (TCM) has been widely used and has accumulated rich experience in the treatment of RHF due to its unique efficacy and safety advantages. Based on this, we comprehensively summarized and analyzed the clinical evidence and mechanism of action of TCM in the treatment of RHF and proposed urgent scientific issues and future research strategies for the treatment of RHF with TCM, to provide reference for the treatment of RHF., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Guo, Yang, Feng, Liu, Li, Zhuang and Ren.)

Objective To evaluate the efficacy and safety of continuous renal replacement therapy (CRRT) combined recombinant human brian natriuretic peptidein (rh BNP) in treatment of refractory heart failure. Methods Eighty patients with refractory heart failure who were treated in Cardiac Care Unit of the hospital from June 2017 to June 2019 were selected, and randomly dev ided into the control group and the observation group, with 40 cases in each group. T he control group received rh BNP on the basis of routine treatment, rh BNP and CRRT were combined on the basis of routine treatment in the observation group. After 7 d of treatment, the efficacy, changes of cardiac function indexes [left ventricle ejection fraction (L VEF) , N terminal probrain natriuretic peptide (NT pro BNP) ], non invasive hemodynamic indexes [cardiac output (CO) , cardiac index (CD ], inflammatory factors [high sensitivity C reactive protein (hs CRP) , tumor necrosis factor a (TNF a) ], and the occurrence of major adverse events were ob served in the two groups. Results The total effective rate of the observation group was significantly higher than that in the control group, the difference was statistically significant (P

This study was designed to evaluate the effects of alprostadil on patients with refractory heart failure receiving statin treatment. One hundred patients with refractory heart failure were categorized into two groups, control (n = 50) and intervention (n = 50). The control group was treated with statins only, while the intervention group received a combination treatment with alprostadil and statins. Total effective rate, New York Heart Association (NYHA) functional classification, quality of life (QOL) score, ventricular remodeling indices, oxidative stress indices, inflammatory factor index, and the serum levels of B-type natriuretic peptide (BNP), blood lipid, blood glucose, and insulin were compared between the two groups. The total effective rate of the intervention group was significantly higher than that of the control group. Following treatment, the intervention group experienced more significant improvements in terms of NYHA functional class, QOL scores, ventricular remodeling indices, oxidative stress indices, and serum levels of inflammatory factor, BNP, blood lipid, blood glucose, and insulin compared with the control group. Administration of alprostadil to patients with refractory heart failure receiving statin treatment can increase the total effective rate; down-regulate serum levels of inflammatory factor, BNP, blood lipid, and blood glucose; and improve insulin resistance, illustrating its value in this clinical application. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of sacubitril/valsartan on ventricular remodeling and prognosis of patients with refractory heart failure. Methods: 150 patients with refractory heart failure who were treated in the department of Cardiology, Minhang Hospital, Fudan University from September 2017 to December 2017 were divided into two groups. The control group(n=75) was given guidelines guide drug treatment(GDMT), and the treatment group(n=75) was given sacubitril/valsartan on the basis of control group,with a starting dose of 50 mg/time and 2 times/d, doubling every 2-4 weeks until the dose reached the maintenance dose of 200 mg/time and 2 times/d. All patients were treated for 4 weeks. The changes of left ventricular structure and function, serum neurohormones and NT-pro BNP levels were analyzed before and after treatment, between two groups. At the same time, the incidence of adverse effects during treatment and the prognosis during follow-up were observed and compared. Results: After treatment, the left ventricular end systolic diameter(LVESD), left ventricular end-diastolic diameter(LVEDD) of treatment group were significantly lower than those before treatment, the left ventricular ejection fraction(LVEF) was significantly higher than before treatment, and these indicators in the treatment group were superior to those of the control group(P <0.05). After treatment, the levels of serum renin activity(RA), renin nervous element(Ang Ⅱ) and NT-pro BNP of both groups were all significantly lower than those before treatment, which were also lower in the treatment group than those of the control group(P <0.05). No significant difference was found in the incidence of complications between two groups(P >0.05). The rehospitalization rate and cardiogenic mortality rate of treatment group were significantly lower than those in control group(P<0.05). Conclusions: Sacubitril/valsartan can effectively improve the cardiac function,reverse the cardiac remodeling and reduce the hospitalization rate and mortality rate without increasing adverse reactions in the treatment of refractory heart failure. [ABSTRACT FROM AUTHOR]

Diuretics are the mainstay of treatment of refractory heart failure. There is a high incidence of dyselectrolytemia and suboptimal response due to diuretic resistance. Ultrafiltration by peritoneal route can be a safe and effective alternative. This study aims to study the ultrafiltration by peritoneal route in refractory heart failure patients with respect to change in functional status, renal parameters, left ventricular ejection fraction, number of days of hospitalization, and level of myocardial depressant factors. This was a prospective observational study conducted in Nephrology Department of tertiary care hospital. We studied patients with refractory heart failure who had persistent symptoms requiring frequent admissions despite optimal medical decongestion or had dyselectrolytemia with worsening renal parameters. The data were collected at baseline and then after 6 months of starting ultrafiltration. A total of 30 participants were studied. All the patients were in NYHA functional status Class IV before peritoneal ultrafiltration. There was a significant improvement in functional status and only 14 patients (46%) had Class III to Class IV status after application of ultrafiltration. (P < 0.001) There was a significant improvement in duration of hospital stay (75.8 ± 43.3 days to 7.8 ± 12.4, P > 0.001), serum creatinine (3.18 ± 0.98 to 2.16 ± 0.79 mg/dl, P < 0.001), and left ventricular ejection fraction [29.3 ± 7.4 (%) to 48.5 ± 11.8 (%), P < 0.0001] post ultrafiltration. There was also significant improvement in level of myocardial depressant factors (IL 1, IL 6, TNF alpha). Ultrafiltration by peritoneal route seems to be an effective alternative and should be offered to patients with chronic heart failure who are symptomatic despite maximal medical treatment. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of ultrafiltration dehydration device in the treatment of refractory heart failure patients. Methods: 70 patients with refractory heart failure treated in our hospital in recent 3 years were selected as the research objects, and ultrafiltration dehydration device was used for ultrafiltration treatment. 4 weeks later, observe and evaluate the clinical curative effects of the patients, and the physiological indexes of patients before and after treatment were compared in patients including heart rate, body weight, mean arterial pressure, and improve the renal function index of patients with cardiac function. Results: (1) the total effective rate of ultrafiltration in the treatment of refractory heart failure patients was 97.14%(68/70), and the clinical efficacy was remarkable. (2) after the treatment of patients with heart rate, body weight, Medical Association Dyspnea Scale (Medical Research Council scale, MRC) respectively (94.12 + 10.21) /min, (65.97 + 6.89)Kg, (2.47 + 1.02)min, was significantly lower than that before treatment (110.67 + 11.83) /min, (71.73 + 7.93)Kg, (3.56 + 1.21)min, the difference was statistically significant (P<0.05). The mean arterial pressure (mean, arterial, pressure, MAP) did not change significantly before and after treatment. (3) heart function indexes of patients after treatment, including cardiac output, left ventricular ejection fraction (Left ventricular ejection fraction, LVEF), B - type natriuretic peptide (brain natriuretic, peptide, BNP) respectively (5.09 + 1.14)L/min, (48.92 + 8.31)%and (1486.34 + 197.95) pg/mL. Significantly better than before treatment respectively (2.32 + 1.01)L/min, (29.76 + 7.09)% and (3979.35 + 646.42) pg/mL, the difference was statistically significant (P<0.05). (4) renal function indexes before and after treatment in patients with glomerular filtration rate (including glomerular filtration rate, GFR), creatinine (creatinine, Cr), blood urea nitrogen (Blood urea, nitrogen, BUN) there was no significant difference in the level of value, that does not affect the renal function of the patients before and after ultrafiltration can. The application of ultrafiltration device in patients with refractory heart failure clinical curative effect of ultrafiltration treatment significantly, can quickly relieve symptoms, improve heart function, and the operation is simple, has high value in clinical application. [ABSTRACT FROM AUTHOR]

Objective: To observe and compare the clinical effects of levosimendan(LEV) and milrinone(MIL) in the treatment of refractory heart failure(RHF) and the effects on the serum N-terminal pro-brain natriuretic peptide(NT-proBNP) and endothelin(ET)-1 levels. Methods: 102 cases of RHF patients admitted in our hospital from January 2015 to April 2017 were selected and divided into the following two groups according to the random number table. MIL group was given MIL treatment, while LEV group was treated with LEV. The clinical efficacy, echocardiographic index [left ventricular ejection fraction(LVEF), early diastolic mitral valve/late diastolic peak velocity(E/A), left ventricular end diastolic diameter(LVIDd) ] and serum NT-proBNP and ET-1 levels before and after the treatment and incidence of adverse reaction were compared between the two groups. Results: After 7 days’ treatment, the total effective rate of LEV group was significantly higher than that of the MIL group(P<0.05). Compared with those before the treatment, the LVEF and E/A of two groups after 7 days’ treatment were significantly increased(P<0.01), while the LVIDd levels were significantly decreased(P<0.01).The LVEF and E/A of LEV group were significantly higher than those of the MIL group(P<0.01), while LVIDd level was obviously lower. The levels of serum NT-proBNP and ET-1 levels of two groups after 7 days’ treatment were were significantly lower than those before the treatment(P<0.01), which were significantly lower in the LEV group than those of the MIL group(P<0.01). The incidence rate of adverse reaction of LEV group was significantly lower than that of the MIL group(P<0.05). Conclusion: Compared with MIL, LEV can alleviate or eliminate the symptoms and signs, inhibit ventricular remodeling and improve cardiac function with better safety in the treatment of heart failure, which might be related to the decrease of serum serum NT-proBNP and ET-1 levels. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effects of continuous load volume new living factor on the refractory heart failure. Methods: 65 cases of patients with refractory heart failure patients were randomly divided into two groups. The contr ol group was given conventional treatment and Nitroglycerin Injection, and the observation group was given new living factor with conventional treatment. The curative effect, changes of pulmonary artery wedge pressure (PAWP). pulmonary artery pressure (PAP), serum anti hs-CRP. brain natriuretic peptide (BNP) levels before treatment and at 24. 36.48 h after treatment were compared between the two gr oups. Results: After treatment, the effective rate of observation group was 87.9%, which was higher than that of the control group (65.6%, P<0.05). The reduction value of PAWP and PAP levels of both groups were gradually increased at 24. 36. 48 h after treatment, which were significantly higher in the observation group than those of the control gr oup at the same time points(P<0.05). At 24. 36. 4S h after treatment, the serum hs-CRP and BNP levels were decreased with the extension of treatment time (P<0.05). which were significantly lower in the observation group than those of the control group at the same tune points (P<0.05). Conclusion: Based On the conventional treatment, continuous loading volume of new living factor can improve the therapeutic effect, and reduce cardiac preload. hs-CRP and BNP levels, improve the myocardial remodeling of patients with refractory heart failure. [ABSTRACT FROM AUTHOR]

Objective:To discuss the efficacy of levosimendan combined with furosemide in treatment of refractory heart failure.Methds:80 patients with refractory heart failure were selected,they were divided into two groups randomly.The control group(39 cases)was given levosimendan,and the observation group(41 cases) was given levosimendan combined with furosemide.The clinical efficacy of levosimendan combined with furosemide in treatment of refractory heart failure was evaluated by efficacy,SV,LVEF,NT-proBNP after 24 h treatment and adverse reactions during 3 days follow-up.Results:After treatment,the heart function improved 1 grade was 37 cases in the observation group and 28 cases in the control group.The effective rate of observation group was higher than that of the control group(P<0.05).Before treatment,there were no statistical significance on SV,LVEF,NT-proBNP between two groups(P>0.05).After treatment,the SV and LVEF were increased in two groups(P<0.05).The SV and LVEF of observation group was higher than that of the control group(P<0.05).After treatment,the NT-proBNP were decreased in two groups(P<0.05).The NT-proBNP of observation group was lower than that of the control group(P<0.05).During 3 days follow-up,there were no statistical significance on adverse reactions between two groups(P>0.05).Conclusions:Levosimendan combined with furosemide had a good therapeutic effect on refractory heart failure.It can enhance heart contractility,improve cardiac output and reduce the degree of heart failure. [ABSTRACT FROM AUTHOR]

Background: The newer Left Ventricular Assist Device (LVAD), the HeartMate 3 (HM3), was initially approved by the Food and Drug Administration in 2017. We aimed to describe the temporal trends of in-hospital stroke and mortality among patients who underwent LVAD placement between 2017 and 2019., Methods: The National Inpatient Sample was queried from 2017 to 2019 to identify all adults with heart failure and reduced ejection fraction (HFrEF) who underwent LVAD implantation using the International Classification of Diseases 10th Revision codes. The Cochran-Armitage test was conducted to assess the linear trend of in-hospital stroke and mortality. In addition, multivariable regression analysis was conducted to assess the association of LVAD placement with in-hospital stroke and death., Results: A total of 5,087,280 patients met the selection criteria. Of those, 11,750 (0.2%) underwent LVAD implantation. There was a downtrend in in-hospital mortality per year (trend: -1.8%, p  = 0.03), but not in the trend of both ischemic and hemorrhagic stroke per year. LVAD placement was associated with greater odds of stroke of any type (OR = 1.96, 95% CI 1.68-2.29, p  < 0.001) and in-hospital mortality (OR = 1.37, 95% CI 1.16-1.61, p  < 0.001)., Conclusions: Our study found a significant downtrend in the in-hospital mortality rates among patients with LVAD without substantial changes in stroke rate trends over the study timeframe. As stroke rates remained steady, we hypothesize that improved management along with better control of blood pressure, could have played an important role in survival benefit over the study time frame.

Objective: To study the clinical effect of continuous blood purification (CBP) combined with hemoperfiision (HP) on diabetic nephropathy (DN) patients complicated with refractory heart failure (RHF). Methods: 60 cases of diabetic nephropathy complicated with refractory heart failure were selected as the research objects. They were randomly divided into the control group and the study group according to the order of hospitalization. There were 30 cases in each group. The control group received conventional symptomatic treatment, while on the basis of conventional symptomatic treatment, the study group received CBP combmed with HP technique. The changes of renal and cardiac function in both groups were compared. Results: After treatment, the total effective rate, miprovement rate and the 1-year survival rate of the study group were significantly higher than those of the control group (P<0.05). The renal and cardiac function mdexes of the control group were significantly improved than before treatment (except Scr and E/A). While each renal and cardiac function mdex of the study group were significantly improved than before treatment, and were significantly better than those of the control group, the difference was statistically significant (P<0.05). Conclusion: CBP combmed with HP was more effective than conventional drugs symptomatic treatment in the treatment of DN complicated with RHF. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effects of 50 % glucose injection combined with continuous pump of furosemide in treatment of refractory heart failure. Methods: 62 cases of patients with refractory heart failure were randomly divided into combined treatment group and control group. Each group had 31 cases. Patents in combined treatment group were taken 50 % glucose 100 m L intravenous combined with 100 mg furosemide continuous intravenous infusion, while in control group were given 300 mg furosemide intermittent injection. The clinical effects of the two groups were recorded. The volume of urine in 24 hours, the concerntration of brain natriuretic peptide(BNP), cardiac index(CI), left ventricular diastolic diameter(LVEDD) around and left ventricular ejection fraction(LVEF) changes before and after treatment were compared. Results: The total efficiency rate of patients in combined treatment group was90.3 %, which was much higher than 64.5 % of the control group(P<0.05). After treatment, the volume of 24 h urines of the two groups was increased, while the BNP concentration was reduced, the differences were all statistically significant(P<0.05). The volume of 24 h urine in the combined treatment group was more than that of the control group, while BNP concentration was less than that of the control group, the differences were all statistically significant(P<0.05). After treatment, the CI and LVEF of patients in the two groups was all increased than before treatment(P<0.05), but the LVEDD had no significant difference compared with before treatment(P<0.05). The CI and LVEF of patients was much higher in combined treatment group than the control group(P<0.05). Conclusions: The short-term clinical effects of 50 % glucose intravenous combined with continuous infusion of furosemide were significant in treatment of refractory heart failure. It could significantly reduce water and sodium retention, reduce swelling and improve heart function. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into llie clinical efficacy of low-dose dopamine combined with intravenous infusion of furacemi on refractory liearl failure. METHODS: 60 patients with refractory heart failure admitted into Tianjin Medical University General Hospital Binhai Hospital from Jan. 2016 to Feb. 2018 were extracted to be randomly divided observation group and control group, with 30 cases in each. The control group was given intravenous infusion of furacemi, while the observation group additionally received low-dose dopamine based on the control group. Differences of clinical efficacy, cardiac parameters of two groups were compared. RESULTS:The total effective rale of observation group was 90.00% (27/30), significantly higher than that of control group (66.67%, 20/30), with statistically significant difference (P < 0. 05). After treatment, the left ventricular ejection fraction, left ventricular end diastolic diameter and plasma N-terminal B-lype pro-brain natriuretic peptide in observation group were significantly belter than those in control group, and the differences were statistically significant (P < 0. 05). CONCLUSIONS:Low-dose dopamine combined with intravenous infusion of furacemi on refractory heart failure can not only improve the efficiency of treatment but also improve the cardiac function. [ABSTRACT FROM AUTHOR]

Background Previous studies have demonstrated hemodynamic and clinical benefits associated with chronic inhibition of 5-phosphodiesterase with sildenafil therapy for heart failure patients. However, its effects in refractory heart failure following cardiac surgery are unknown. Objective To evaluate the clinical benefits of sildenafil addition to standard therapy in patients with advanced (refractory) heart failure after cardiac surgery. Methods A prospective single-arm study which was done on 26 patients with refractory heart failure after cardiac surgery despite receiving the standard anti-failure treatment, from September 2012 to June 2013. Patients were included into one group and were evaluated before and after 1, 2 and 3 months of sildenafil addition to the standard anti-failure treatment. Results Add-on sildenafil treatment resulted in significant increase in cardiac output, ejection fraction and fractional shortening, with significant decrease in left ventricular systolic internal diameter, end systolic volume, right ventricular pressure and pulmonary hypertension. Consistently, there were significant improvements in signs and symptoms of heart failure, New York Heart Association Class, with marked improvement in the patients' clinical status. There were no significant changes in heart rate, left ventricular diastolic internal diameter and end diastolic volume. There were no significant adverse events and the reported four cases of mortality (15.4%) were died due to different causes and none was associated with sildenafil therapy. Conclusion We demonstrated that sildenafil use improves signs and symptoms of heart failure, NYHA class, echocardiographic parameters and quality of life in patients with refractory heart failure following cardiac surgery. [ABSTRACT FROM AUTHOR]

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Abstract: Heart transplantation (HTx) is considered the “gold standard” therapy of refractory heart failure (HF), but it is accessible only to few patients because of the paucity of suitable heart donors. On the other hand, left ventricular assist devices (LVADs) have proven to be effective in improving survival and quality of life in patients with refractory HF. The challenge encountered by multidisciplinary teams in dealing with advanced HF lies in identifying patients who could benefit more from HTx as compared to LVAD implantation and the appropriate timing. The decision-making is based on clinical parameters, imaging-based data and risk scores. Current outcome of HF patients supported by LVAD (2-year survival around 70%) is rapidly improving and leads the way to a new therapeutic strategy. Patients who have a low likelihood to gain access to the heart graft pool could benefit more from LVAD implantation (defined as bridge to transplantation indication) than from remaining on HTx waiting list with the likely risk of clinical deterioration or removal from the list because patients are no longer suitable for transplantation. LVAD has also demonstrated to be effective in patients who are not considered eligible candidates for HTx with a destination therapy indication. HTx should be reserved to those patients for whom the maximum clinical benefit can be expected, such as young patients with no comorbidities. Here we discuss the current listing criteria for HTx and indications to implant of LVAD for patients with refractory acute and chronic HF based on the guidelines and the practical experience of our center. [Copyright &y& Elsevier]